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Pediatr Nephrol 33:11651172

Ellsworth, M.D

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For a pre-service claim the category a prior authorization falls into notification of the plan's benefit determination must come "within a reasonable period of time appropriate to the medical circumstances, but not later than 15 days after receipt of the claim." That period may be "extended one time by the plan for up to 15 days" where the plan administrator determines an extension is necessary